M, T, Th, Fr from 9am-4pm Riverwoods at Denton

M, T, Th, Fr from 9am-4pm

Riverwoods at Denton

Thank you for your interest in our community!

In order to get on our waiting list and process you for one of our beautiful units, we

will need the following:

• This application package completed and in BLACK INK ONLY

• For each ADULT listed on the application:

Valid government issued Photo ID

Social Security Card

$16.00 non-refundable application fee payable by money order only

Signature in all four places in the application package

• For each MINOR (under 18 years of age) listed on the application:

Birth Certificate or Birth Registration

Social Security Card

We cannot accept the application unless all of the above items are included with it.

Copies can initially be accepted for ID, social security cards and birth

certificates/registrations, with the application. However, originals will be needed

prior to lease signing. We will make the copies for you.

Once you turn in the above completed package, you will be placed on the waiting

list for the requested bedroom size in the set aside that you pre-qualify for.

Once submitted, please be sure to update us (in writing) with any changes in your

contact information (address, phone and/or email). These changes can be emailed

to [email protected] or sent to the address below.

We look forward to making Riverwoods at Denton your home!

101 Quinn Circle, Denton, MD 21629 443-448-7980 phone TTY: Dial 711 443-448-7982 fax

Revised 08.12.20

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Habitat America, LLC, Management Company RESIDENT SELECTION CRITERIA

For Tax Credit Properties

Property Name: Village Circle, LLC dba Riverwoods at Denton Effective Date: January 21, 2022 101 Quinn Circle, Denton, MD 21629 PH: 443-448-7980 TTY: 711

Thank you for applying to live at our community. This document is provided to you to explain the process we use to select our residents. Habitat America, LLC is an Equal Housing Opportunity provider. It is our policy to treat all residents and visitors at our properties fairly and consistently without regard to race, color, religion, sex, national origin, disability, familial status, sexual orientation, gender identity, marital status or source of income. This community and its employees comply with the provisions of Title VIII of the Civil Rights Act of 1968, the Fair Housing Amendments Act of 1988 (“Fair Housing Act”) and, to the extent applicable, the Americans with Disabilities Act. Furthermore this community complies with the State and Local fair housing regulations of the jurisdictions in which it is located.

PROJECT ELIGIBILITY This community may be designated for a special population. Applicants must be adults and must meet the restrictions as indicated below in order to proceed with the application process. No special population restrictions apply to this community. Valid identification with a picture will be required (photo copy may be kept on file). Applicants must disclose social security numbers (SSN) for all family members. A valid SSN card issued by the Social Security Administration is the necessary documentation required. If a SSN card is not available the community will accept a letter from the Social Security Administration stating that a new card has been applied for. Where applicable an assigned Federal Identification Number may be used. United States Code Title 8, subsection 1324 (a) (1) (A) prohibits the harboring of illegal aliens. The provision of housing to illegal aliens is a fundamental component of harboring. All applicants will be required to provide proof of citizenship or legal immigration status.

STUDENTS This community follows the student regulations written in Section 42 of the Internal Revenue Code. The regulation states that a household comprised of all full time students will not be eligible for this program. There are five exceptions to this rule. For more information contact the Community Manager.

OCCUPANCY STANDARDS

Habitat America, LLC has established occupancy standards to permit the resident to select the apartment size they deem appropriate to their needs while preventing overcrowding and underutilization of the apartment. The occupancy standard is based on 2 persons per bedroom plus one: Note: Children under 2 may not be counted towards number of occupants allowed, and no adult members can be added to the household in the first 12 months of occupancy that would compromise the tax credit section 42 restrictions.

Number of Bedrooms Minimum & Maximum Occupants Allowed 1 1 - 3 2 1 - 5 3 2 - 7

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INCOME REQUIREMENTS The household’s total gross annual income shall not exceed the property’s applicable area median income as posted by HUD each year. All forms of household income must be disclosed. In addition, minimum income limits apply. Proof of all income and assets is required.

TAKING APPLICATIONS The Application: Each adult (18 years of age or older, or emancipated) must complete and sign the Rental Application. There is a non-refundable application fee of $16 per adult. An application cannot be processed unless it is fully complete. Applicants must list all members who will reside in the apartment unit and designate the number of bedrooms being requested. Apartments specially designed for the disabled will be marketed only to persons with disabilities. If an apartment is not available when the application is submitted, the applicant will be put on waiting list. The application will be fully screened and verified when an apartment becomes available for occupancy. Once the application is approved and the available unit accepted, the applicant will be required to sign a lease agreement in which applicant agrees to abide by all property rules and regulations. If assistance is needed in completing the application or lease documents, contact the Community Manager. If any information provided by the applicant proves to be untrue during the verification process, these applications will be denied on the basis of attempted fraud. Screening: A report will be obtained through a commercial credit reporting agency which will determine the application accepted or denied. Credit/Rental History:

• Rental history will be verified and must indicate the ability to care for the property without damage and pay rent on time. Applicants owing balances at other Habitat America properties will be denied.

• Applicant must be able to establish the necessary utilities with the appropriate utility provider and must not have unpaid gas and/or electric bills.

• Discharged bankruptcies will be considered for a period of one year from date of discharge. • Medical bills and student loans are excluded from consideration.

Criminal Background History: Applicant will be denied if:

• Any household member has been evicted from Federally-assisted housing for drug-related criminal activity, or is currently engaging in the illegal use of a drug.

• There is a reasonable cause to believe that a household member’s abuse or pattern of abuse of alcohol and/or an illegal drug may interfere with the health, safety, or right to peaceful enjoyment of the premises for other residents.

• Any household member with a felony conviction of drug-related criminal activity including but not limited to possession (other than marijuana), distribution, transport, sale, manufacture or storage of illegal drugs and/or drug paraphernalia, or conviction of any State or Federal laws relating to illegal drugs and/or paraphernalia.

• Any household member is subject to lifetime registration requirements under a state or federal sex offender registration program.

• Any other criminal history exists that would threaten the health, safety or peaceful enjoyment of the premises by other residents or the health and safety of the owner, employee, contractor, or agent who is involved in the housing operations.

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Rejection Procedures: If an applicant disputes the accuracy of any information provided to the landlord by a screening service or credit reporting agency, the applicant may contact the screening company that supplied the information within 60 days of the denial to obtain a copy of screening results. The name, address and phone number of the screening company will be provided in the denial letter. The denial letter will advise the applicant that if they believe there are errors in their screening report, they have fourteen (14) days to respond in writing to request an appeal. Applicants who are denied must wait 60 days before reapplying at the community.

SECTION 504

Habitat America, LLC developed a Section 504 Policy that addresses all reasonable accommodation requests for persons with disabilities. For more information on reasonable accommodation requests, contact the Community Manager.

RIVERWOODS at DENTON Security Deposit: $250 with Approved credit or 1 month’s rent with Conditional credit Lease Term: 1 year lease Utilities Included: Water, Sewer and Trash Income Requirements & Rental Rates: Total household income will be reviewed and verified for occupancy in our community in accordance with the following maximum and minimum income limits based on family composition. Voucher holders do not have a minimum income requirement but must meet all the other requirements. (Limits are subject to change)

PHASE I & II

Unit Type

Square Footage

Market Rental Rate

Minimum Income

Maximum # of

Occupants Allowed

Maximum Income

1BR / 1 BA 30%

4 units 637 - 638 $354 $12,744 3

1 person - $15,930 2 people - $18,210 3 people - $20,490 4 people - $22,740 5 people - $24,570

2BR / 1BA 30%

5 units 766 – 816

$420 $15,120 5 2BR / 2BA

30% 1 units

889

1BR / 1BA 40%

3 units 637 - 638 $497 $17,892 3 1 person - $21,240

2 people - $24,280 3 people - $27,320 4 people - $30,320 5 people - $32,760

2BR / 1BA 40%

7 units 766 – 816 $591 $21,276 5

2BR / 1BA 50%

2 units 816 $758 $25,469 5

1 person - $26,550 2 people - $30,350 3 people - $34,150 4 people - $37,900 5 people - $40,950

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1BR / 1BA 60%

15 units 637 - 638 $727 $24,427 3 1 person - $31,860

2 people - $36,420 3 people - $40,980 4 people - $45,480 5 people - $49,140

2BR / 1BA 60%

11 units 766 - 816 $855 $28,728 5

Note: 18 units in Phase II will be designed with ramps to the entry of the units. PHASE III

Unit Type

Square Footage

Market Rental Rate

Minimum Income

Maximum # of

Occupants Allowed

Maximum Income

1BR / 1 BA 50%

4 units 794 - 984 $627 $21,067 3 1 person - $26,550

2 people - $30,350 3 people - $34,150 4 people - $37,900 5 people - $40,950

2BR / 1BA 50%

2 units 968 $758 $25,469 5

1BR / 1BA 60%

8 units 794 - 984 $765 $25,704 3 1 person - $31,860

2 people - $36,420 3 people - $40,980 4 people - $45,480 5 people - $49,140

2BR / 1BA 60%

10 units 968 – 1,150 $896 $30,106 5

3BR / 2.5BA 30%

2 units 1,512 $480 $17,280 7

1 person - $15,930 2 people - $18,210 3 people - $20,490 4 people - $22,740 5 people - $24,570 6 people - $26,400 7 people - $28,200

3BR / 2.5BA 60%

10 units 1,512 $1,025 $34,440 7

1 person - $31,860 2 people - $36,420 3 people - $40,980 4 people - $45,480 5 people - $49,140 6 people - $52,800 7 people - $56,400

Additional Preference: 13 units will be designated for housing households with disabilities with incomes at or below 50% AMI, these individuals will be referred by MDOD. Pet Policy: Pets are not accepted. The exceptions are caged birds, turtles and fish in small aquariums (20- gallon max). Reptiles are not permitted. Visiting pets are not permitted at any time. Animals which are designated as assistance animals to the disabled are accepted with the appropriate documentation.

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Smoking/Fire Risk Reduction Policy: Smoking will not be permitted in the units or anywhere on property grounds. Smoking is defined as carrying or inhaling or exhaling smoke from any lighted cigar, cigarette, electronic-cigarette, vaporizer, pipe or consumer product modified for smoking or any other lighted tobacco or plant product. Additionally, burning of incense and candles is prohibited to reduce risk of fire. Also in light of recent hazards related to Hoverboards, Habitat America is prohibiting these devices at all communities, including all common areas and grounds. Beginning August 1, 2016, Hoverboards may not be used, charged or stored anywhere at the communities, including all common areas and grounds. All leaseholders will be required to sign a Non-smoking Lease Addendum agreeing to these rules prior to occupancy. Violence against Women Act The VAWA Act protects victims of domestic violence, dating violence, sexual assault or stalking, as well as their immediate family members generally, from being evicted or being denied housing assistance if an incident of violence that is reported and confirmed. The VAWA also provides that an incident of actual or threatened domestic violence, dating violence or stalking does not qualify as a serious or repeated violation of the lease nor does it constitute good cause for terminating the assistance, tenancy, or occupancy rights of the victim If you need additional information concerning the Selection Criteria, please see the Community Manager. Please note this Resident Selection Criteria in its entirety is subject to change without notice. Acknowledgment/Receipt: By signing below I/We acknowledge that we were given and have received a copy of the Resident Selection Criteria for Riverwoods at Denton. I/We also understand that the property owner may disclose the application status to any agency with program regulations applicable to the community.

Applicant Signature Date

Applicant Signature Date

Management Signature Date

WELCOME TO YOUR NEW APARTMENT HOME!

APPLICATION FOR AFFORDABLE HOUSING

HOUSEHOLD MEMBER INFORMATION - Complete the following information for each household member that will occupy the unit at the time of move in & during next 12 month period - PLEASE PRINT

NAME Last, First, MI (Jr, Sr, Etc.) Social Security Number

Sex M/F

Is this Person a Student? Age Birth Date

MM/DD/YY

Race

Hispanic/

Non-Hispanic

List ALL States

Ever Lived In (Statistical Purposes Only)

HEAD YES NO

CO-H YES NO

3. YES NO

4. YES NO

5. YES NO

6. YES NO

7. YES NO

Do you expect any changes to the above listed household composition (size) in the next 12 months? If yes, explain:

YES NO

Is there someone not listed above who would normally reside in the household? If yes, explain:

YES NO

Will this be your only residence? If no, explain: YES NO Are any household members currently receiving Section 8 assistance? If yes, is the assistance: (circle one) Housing Choice Voucher or Property Based Section 8

YES NO

Are any household members on a waitlist for public housing or any other type of rental assistance? If yes, what agency has the member’s name on its waiting list:

YES NO

RESIDENT HISTORY AND INFORMATION HEAD OF HOUSEHOLD CURRENT ADDRESS & PHONE # Landlord/Mortgage Name & Address Monthly Payment Occupancy Dates Rent $ From: City: Mortgage $ To: State, Zip: City, State, Zip: Phone# Phone# Applicant Email: PREVIOUS ADDRESS (if less than 3 years) Landlord/Mortgage Name & Address Monthly Payment Occupancy Dates Rent $ From: City: Mortgage $ To: State, Zip: City, State, Zip: Phone# Phone# OTHER ADULT HOUSEHOLD MEMBER (If additional space is needed, please use blank page and attach) CURRENT ADDRESS & PHONE # Landlord/Mortgage Name & Address Monthly Payment Occupancy Dates Rent $ From: City: Mortgage $ To: State, Zip: City, State, Zip: Phone# Phone# Applicant Email: EMERGENCY CONTACT INFORMATION NAME: ADDRESS: PHONE: RELATIONSHIP: 1. 2. VEHICLE INFORMATION MAKE/MODEL: PLATE #: COLOR: YEAR:

ADDITIONAL INFORMATION Is any household member listed above subject to a registration requirement under a state sex offender registration program? If so, please list the household member’s name here:

YES

NO

Have you or any household member listed above ever been evicted or foreclosed from any housing? YES NO If yes, describe: Have you or any household member listed above ever filed for bankruptcy? If yes, Date of Discharge: YES NO Is any member of the household listed above a Veteran? YES NO Is any member of the household listed above disabled? If yes, does this household member require any specific accommodations? If yes, select one: ____________ Hearing Accessible _______________ Mobility Accessible ______________ Visually Accessible

YES NO

B/R Size:

App Fee:$

Anticipated Move In Date:

Traffic Source: Agent: Date App.

Received:

Do you or any household member receive or expect to receive income from: Receive

Yes or No

INCOME SOURCE TYPE:

Estimated GROSS Monthly Amount

Name of HH Member(s) Who Receives this Income

How is the money received? (Circle one payment source)

YES

NO

Employment Income (Full-time, Part-Time or Seasonal)

$

Direct Deposit Check Pre-paid Card Cash Employer Name:__________________________ Date of Hire:___________________

Employer Name:__________________________ Date of Hire:___________________

Employment Income (Full-time, Part-Time or Seasonal)

$ Direct Deposit Check Pre-paid Card Cash Employer Name:__________________________ Date of Hire:____________________

Employer Name:__________________________ Date of Hire:____________________

YES NO Social Security

$ Direct Deposit Check Pre-paid Card Cash

YES NO Social Security Supplement – SSI

$ Direct Deposit Check Pre-paid Card Cash

YES NO Social Security Disability – SSDI

$ Direct Deposit Check Pre-paid Card Cash

YES NO Pension Plan Benefits

$ Direct Deposit Check Pre-paid Card Cash

YES NO Veterans Benefits - VA $ Direct Deposit Check Pre-paid Card Cash

YES NO Self-Employment Income

$ Direct Deposit Check Pre-paid Card Cash

YES NO Annuities, IRA or other Retirement

$ Direct Deposit Check Pre-paid Card Cash

YES NO Gifts/Contributions from Outside Source

$ Direct Deposit Check Pre-paid Card Cash

YES NO Military Pay

$ Direct Deposit Check Pre-paid Card Cash

YES NO Does anyone work for a person who pays in cash

$ Direct Deposit Check Pre-paid Card Cash

YES NO Unemployment/Workman’s Comp/Disability

$ Direct Deposit Check Pre-paid Card Cash

YES NO TCA, TANF, General Assistance Benefits (not food stamps)

$ Direct Deposit Check Pre-paid Card Cash

YES NO Child Support, Alimony or Spousal Support It is Court Ordered: Yes or No

$ Direct Deposit Check Pre-paid Card Cash

YES NO Is anyone on Leave of absence from work due to Lay-Off, Medical, Family Leave Act, Military Leave or other

$ Direct Deposit Check Pre-paid Card Cash

YES NO Other income from sources not mentioned above

$ Direct Deposit Check Pre-paid Card Cash

STATEMENT OF ASSET INFORMATION: Do you or any household member listed above have the following assets? Please list current value(s) below

Have (Yes or No) Asset Type Current Value of

this Asset Annual Interest

Income from this Asset

Name of Household Member Who has the asset(s)

YES NO Checking Account (s) # of Accounts:_____ $ $

YES NO Savings/Money Market Accts. # of Accounts:_____ $ $

YES NO Certificate of Deposit (CD) # of Accounts:_____ $ $

YES NO IRA or Annuities # of Accounts:_____ $ $

YES NO 401K, 403B, 457A, etc. # of Accounts:_____ $ $

YES NO Any other Retirement Accts. # of Accounts:_____ $ $

YES NO Savings Bonds/Treasury Bills/ # Owned:_____ Stocks

$ $

YES NO Trust Fund(s) # of Accounts:_____

$ $

STATEMENT OF ANTICIPATED INCOME: For the next 12 months

STATEMENT OF ASSET INFORMATION CONTINUED:

YES

NO Whole/Universal Life Insurance Policies # of Policies:_____

$ $

YES NO Does anyone own any Burial Plot(s) $ $

YES NO

Does anyone own any property or have equity in any real estate? (Homes, Mobile Homes, Land, Condos, Time Share, Commercial Rental or Other Rental Property) If the property is owned, Is it for sale? YES NO

$ $

YES NO Does anyone receive Rental Property Payments or Note Receivable

$

$

YES NO Do you own collections (gems, art, coins, etc.) or any other property which is held as an investment

$ $

YES NO

Have you received or expecting to receive any LUMP SUM PAYMENTS from: Social Security Delayed payments, inheritances, capital gains, one-time lottery winnings, victims restitution, worker’s compensation, disability or any type of insurance claims/settlements

$ $

YES NO Do you have Cash on Hand $ $

YES NO Any other assets not listed above

$ $

Does your total assets value $5,000 or more? YES NO

Does any member of the household have an asset(s) owned jointly with a person who is NOT a member of the household? If yes, please explain:

YES NO

Have you sold any property within the last two years? If yes, please explain:

YES NO

Have you disposed of (given away) any assets within the last two years? If yes, please explain: Date asset(s) was disposed of (given away):____________________________________ The asset(s) I/We disposed of (gave away) was:____________________________________________________ The Fair Market Value of the asset(s) disposed of (gave away) was: $_______________________________ The amount received for the asset I/We Disposed of (if any):$______________________________________

YES NO

Definition of a higher education student is any person enrolled (part-time or full-time) in an institution (tech school, college, university, etc.) for the purposes of earning a degree, certificate or other program leading to a recognized educational credential.

If yes to any of above, who is (or was) enrolled? ________________________ Name of School: _______________________ How is the education paid for? ___________________________ What is the cost of Tuition per semester? $______________

STUDENT INFORMATION – Higher Education

Is any household member currently a student of higher education?

YES NO

Was any household member a student of higher education for any 5 calendar months of this year?

YES NO

Does any household member plan to become a full-time student of higher education in the next calendar year?

YES NO

Are ALL of the persons in this household Full-time Student(s)?

YES NO

MEDICAL EXPENSES

Type of Expenses Family Member Who Pays Monthly Amount

PET & ASSISTANCE ANIMALS

Please review the property pet/assistance animal rules. The presence of any animal must be approved before the animal is allowed to be kept in the unit. Do you plan to house an Animal? YES ________ NO _________ If Yes, Provide the following information:

Animal Type (dog, cat, bird, etc.) Breed (if applicable) Weight (full grown) Is the animal a Service animal required to assist with a disability? YES NO

YES NO

FRAUD STATEMENT Title 18 Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person, who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security numbers are contained in the Social Security Act at 208 (a) (6), (7) and (8). Violations of these provisions are cited as violations of 42 U.S.C. Section 408 (a) (6), (7) and (8)

RESIDENT’S STATEMENT WE UNDERSTAND THAT THE ABOVE INFORMATION IS BEING COLLECTED TO DETERMINE MY ELIGIBILTY FOR RESIDENCY. I/WE AUTHORIZE THE OWNER/MANAGER TO VERIFY ALL INFORMATION PROVIDED ON THIS APPLICATION/CERTIFICATION AND MY/OUR SIGNATURE IS CONSENT TO OBTAIN SUCH VERIFICATIONS. I/WE UNDERSTAND THAT SCREENING WILL BE COMPLETED BY A CREDIT REPORTING AGENCY IN ACCORDANCE WITH TENANT SELECTION PLAN. I/WE CERTIFY THAT I/WE HAVE REVEALED ALL INCOME AND ASSETS AND ASSETS DISPOSED. I/WE FURTHER CERTIFY THAT THE STATEMENTS MADE IN THIS APPLICATION/CERTIFICATION ARE TRUE AND COMPLETE TO THE BEST OF MY/OUR KNOWLEDGE AND BELIEF AND ARE AWARE THAT FALSE STATEMENTS ARE PUNISHABLE UNDER FEDERAL LAW. I/WE UNDERSTAND THAT ANY INCOMPLETE APPLICATION WILL NOT BE PROCESSED. __________________________________________________________________________________ __________________ SIGNATURE OF HEAD OF HOUSEHOLD DATE __________________________________________________________________________________ __________________ SIGNATURE OF CO-TENANT DATE __________________________________________________________________________________ __________________ SIGNATURE OF CO-TENANT DATE __________________________________________________________________________________ __________________ SIGNATURE OF CO-TENANT DATE

OWNER’S SIGNATURE SIGNATURE OF OWNER’S/MANAGEMENT AGENT AUTHORIZED REPRESENTATIVE: __________________________________________________________ DATE ___________________________________

Habitat America, LLC is an Equal Housing Opportunity provider. It is our policy to treat all residents and visitors fairly and consistently without regard to race, color, religion, sex, national origin, disability, familial status, sexual orientation, gender identity or marital status. Habitat America, LLC and its employees comply with the provisions of Title VIII of the Civil Rights Act of 1968, the Fair Housing Amendments Act of 1988, and, to the extent applicable, the Americans with Disabilities Act. Furthermore this community complies with the State and Local fair housing regulations of the jurisdictions in which it is located.

Rev: 07/08/2021

“I hereby authorize Village Circle, LLC dba Riverwoods at Denton to obtain a consumer report, and any other information it deems necessary, for the purpose of evaluating my application. I understand that such information may include, but is not limited to, credit history, civil and criminal information, records of arrest, rental history, employment salary details, and/or any other necessary information.” “I hereby expressly release Village Circle, LLC dba Riverwoods at Denton, and any procurer or furnisher of information, from any liability whatsoever in the use, procurement, or furnishing of such information, and understand that my application information may be provided to various local, state and/or federal government agencies, including without limitation, various law enforcement agencies.” “I understand that should I lease an apartment, Village Circle, LLC dba Riverwoods at Denton, through its agents, assignees and employees, shall have a continuing right to review my consumer report information, rental application, payment history and occupancy history for account review purposes, future renewal consideration, collection purposes and for improving application methods.” __________________________________ ________________________ Applicant or Co-signer Signature Date __________________________________ ________________________ Applicant or Co-signer Signature Date __________________________________ ________________________ Applicant or Co-signer Signature Date __________________________________ ________________________ Applicant or Co-signer Signature Date ___________________________________ ________________________ Community Manager/Agent’s Signature

Rev: 08/2018

APPLICANT or CO-SIGNER CONSENT

Village Circle, LLC dba Riverwoods at Denton

(Property Name)

NOTICE OF DISCLOSURE FOR APPLICATION

As provided by the Maryland Personal Information Protection Act of 2008, anyone who is requested to provide personal information about himself must be informed whether he/she is legally required to provide such information, or whether he/she may refuse to supply the information requested. As an applicant for housing he/she is required to provide certain information that will enable Habitat America, LLC to complete the eligibility process for Section 42 Low Income Housing Tax Credit Program or other federal housing programs. A Photostat or facsimile copy of your signature may be used to retrieve information required to determine gross annual income. It may be used to verify information listed on our application or re-certifications for the purpose of approval and/or retrieval of income and asset information during the compliance period of the property, deemed necessary for the Section 42 Low Income Housing Tax Credit Program or other federal housing program guidelines set forth for this property. Your signature below indicates authorization to request verifications of necessary information concerning any income or asset sources by phone, fax or Photostat copy of this form, along with the necessary identifying verification form during the declared compliance period of this property. The information requested will be used to determine an adjusted annual income, which you and your family receive from all income sources. This is necessary because the Rules and Regulations adopted pursuant to the Authority conferred on the Maryland Department of Housing and Community Development limit eligibility for initial occupancy to families whose adjusted income does not exceed certain established limits. In addition, it is necessary to know the composition of your family (number of dependents) so that the proper size of dwelling unit may be authorized for you and your family. Although you are not legally required to provide the information requested, your failure to do so will result in our inability to determine your eligibility for housing in this development. This paperwork is retained in your file and is subject to audits by Maryland Department of Housing and Community Development, 7800 Harkins Road, Lanham, Maryland, 20706. It is possible that information provided by you will be revealed to others for the purpose of confirmation or for other purposes in accordance with the Maryland Freedom of Information Act, but any information so supplied is subject to the safeguards of the Maryland Personal Information Protection Act. My/Our signature(s) below indicate my/our acceptance of the application for occupancy in its entirety.

______________________________________ __________________________________ Applicant #1 Signature Date ______________________________________ __________________________________ Applicant #2 Signature Date ______________________________________ __________________________________ Applicant #3 Signature Date ______________________________________ ___________________________________ Authorized Agent Habitat America, LLC Date

Rev: 10/2017

PRIVACY PROTECTION ACT LETTER (Maryland)